In the case of Moreau v. Transp. Ins. Co., the workers’ compensation insurance carrier for a Montana mining company had agreed to accept liability for medical expenses of a former worker who died of asbestos-related lung cancer.
However, the company had established and funded a medical plan to pay for the medical expenses of workers injured by exposure to asbestos, and both the plan and employer declined to accept the insurer reimbursement for this worker. The worker’s widow, as personal representative of his estate, asserted the reimbursement should be paid either to his estate or to a charity chosen by the estate.
But the insurer wouldn’t pay the money for this purpose, so the estate filed an action with the state Workers’ Compensation Court. Initially, the petition was denied on grounds it lacked jurisdiction because the estate lacked standing. However, the Montana Supreme Court disagreed, reversing and remanding.
According to court records, the decedent worker at the center of the dispute was employed at the mine from 1963 until 1992. As is common with asbestos-related disease, his illness was not detected until decades later, and he died in 2009 of mesothelioma in the lining of his lungs.
Initially when his widow filed a claim with the mine’s workers’ compensation insurance carrier for death benefits, the carrier denied the claim. After filing a petition with the WCC against the carrier for a determination on liability for costs of her husband’s medical care, the carrier finally agreed to cover his medical expenses and entered into a settlement agreement.
The carrier then reimbursed Medicaid, as well as other providers and the widow individually for medical expenses paid for his care. One of those other providers was the medical plan established by the employer, which had covered $95,000 of worker’s medical bills.
When neither the employer nor the plan would accept reimbursement for these costs (the reasons why are not clear), the widow demanded the amount be paid either to the estate or a charity.
The workers’ compensation court reasoned that because the estate was not liable to make payments to the plan or the employer, she had no right to demand additional reimbursement from the insurance carrier.
Our Asheville workers’ compensation lawyers understand on appeal, the state supreme court reasoned the WCC has the jurisdiction on any dispute involving benefits. Whether a party lacks standing or not doesn’t affect the court’s subject matter jurisdiction, and this case unquestionably dealt with the issue of workers’ compensation medical benefits and entitlement of payment thereof.
The carrier agreed that it should cover all medical expenses of the worker and it had agreed upon settlement to cover those claims. Whether the company should still have to pay the money despite the employer’s refusal is a matter the court does have jurisdiction to decide.
The court ruled that while the estate did have standing to have the case heard on its merits, it expressed no opinion as to the merits of the claim. The case was remanded back to the workers’ compensation court in order to be fully considered.
If you have been injured at work, contact the Lee Law Offices at 800-887-1965.
Moreau v. Transp. Ins. Co., Jan. 6, 2015, Montana Suprem Court
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